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1 Medicaid Health Plans of America April 20, 2006 Washington, D.C. John Lovelace, Vice President UPMC Health Plan

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2 ENROLLMENT COMPARISONS All SNP versus Utilizing Members Medical and Pharmacy Medical or Pharmacy Medical Only Pharmacy Only (By Race and By Age)

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3 Race Comparison Medical or Pharmacy Expenses

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4 Race Comparison Medical And Pharmacy Expenses

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5 Race Comparison Medical Expenses Only

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6 Race Comparison Pharmacy Expenses Only

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7 Age Comparison Data Tables UNIQUE MEMBERS TOTAL SNP POPULATION % OF TOTAL SNP POPULATION MEDICAL OR PHARMACY EXPENSES % OF T O T A L MEDICAL AND PHARMAC Y EXPENSE S % OF TOTA L Under 65 Years of Age7,26758.4%6,31586.9%4,82766.4% Over 65 Years of Age5,17241.6%4,59788.9%3,55568.7% Total Unique Members12,439100.0%10,91287.7%8,38267.4% UNDER 65 UNIQUE MEMBERS PHARMACY EXPENSES ONLY% OF TOTAL MEDICAL EXPENSES ONLY% OF TOTAL Under 65 Years of Age2,07728.6%1,31518.1% Over 65 Years of Age1,39627.0%79615.4% Total Unique Members3,47331.8%2,11160.8%

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8 Age Comparison Medical or Pharmacy Expenses

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9 Age Comparison Medical and Pharmacy Expenses

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10 Risk Score Comparison By Race, Age Group SNP versus Total Medicare Population

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11 Average Risk Score by Race and by Age Group

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12 Average Risk Score SNP compared to All Other Medicare Members

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13 MEDICAL EXPENSE ANALYSIS Claim Stratification (No IBNR) Unique Member (IBNR) Gender Race Financial Service Category Inpatient, Outpatient, PCP, etc

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14 Claim Stratification Under 65 Years of Age (Total Medical and Pharmacy Expenses No IBNR)

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15 Claim Stratification Over 65 Years of Age (Total Medical and Pharmacy Expenses No IBNR)

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16 Medical Expense Utilization Unique Members Age, Gender

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17 Medical Expense Utilization Unique Members Age, Gender - PMPM

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18 Medical Expense Utilization by Race

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19 Medical Expense Utilization by Race, Age Unique Members

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20 Medical Expense Utilization by Race, Age PMPM

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21 Medical Expense Utilization by Financial Service Category PMPM

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22 Medical Expense Utilization by Financial Service Category, by Age Group Unique Members

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23 Medical Expense Utilization by Financial Service Category, by Age Group PMPM

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24 SNP Population Comparison All Other Medicare Members SSI/Medicaid

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25 SNP Payment Comparison Medicare/SSI

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26 SNP Comparison to Medicare/SSI Prescriptions per Member

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27 SNP Comparison Medicare/SSI RX: Generic v Brand Scripts

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28 SNP Comparison Medicare/SSI RX: Generic v Brand - Payment

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29 Pharmacy Utilization SNP versus Medicare/SSI The top ten drugs (by payment) for the Special Needs Program (SNP) membership account for 30% of total pharmacy payments and 11% of total prescriptions. Included in the top ten are four medications used for schizophrenia / bipolar disorder (Zyprexa, Seroquel, Risperdal and Abilify). Also included are Zocor and Lipitor (cholesterol medications), Plaviax (blood clot prevention), Topamaz (migraines / seizures), Advair Diskus (asthma medication) and Oxycodone (pain). For the SSI membership within Medical Assistance, these same ten drugs account for 26% of pharmacy payments and 8% of total prescriptions. For the rest of Medicare (excluding SNP), only the cholesterol medications (Zocor and Lipitor), Plavix and Advair Diskus are in the top ten drugs by payment. However, these same ten drugs still account for 25% of payments and 8% of prescriptions for the rest of Medicare. Other drugs utilized frequently by the SNP population and other Medicare members include One Touch Ultra Strips and Actos (diabetes medications), Fosamax (osteoporosis) and Remicade (rheumatoid arthritis / Chrohn's Disease)

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30 Pharmacy Utilization SNP Population Utilizing Members Prescriptions per 1000 PMPM Top 10 Drugs/Therapy Classes Rx Utilization for Members > 6 Drugs Rx Utilization Trends

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31 Pharmacy Utilization SNP Population UNDER 65OVER 65ALL SNP MEMBER MONTHS20,43614,60035,036 UTILIZING MEMBERS5,9524,37610,328 PMPM$337.70$216.41$287.16 PRESCRIPTIONS PER 100049,883.154,512.951,812.4

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32 Pharmacy Utilization SNP Population

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33 Pharmacy Utilization SNP Population

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34 Pharmacy Utilization SNP Population

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35 Pharmacy Utilization SNP Population By Race

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36 Pharmacy Utilization SNP Population By Race

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37 Pharmacy Utilization SNP Population By Race

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38 Pharmacy Utilization SNP Population By Gender

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39 Pharmacy Utilization SNP Population By Gender

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40 SNP Population Top 10 Drugs DRUGS FIRST QUARTER 2006 Rank Drug Name PMPM% of Rx PMPMScripts / 1,000Cost / Unit 1 ZYPREXA $ 15.655.5%445.3 $ 421.83 2 SEROQUEL 12.154.2%626.1 232.89 3 ZOCOR 11.203.9%1,032.7 130.10 4 RISPERDAL 10.713.7%548.0 234.44 5 LIPITOR 10.073.5%1,352.2 89.39 6 ABILIFY 6.862.4%228.5 360.13 7 PLAVIX 5.752.0%568.6 121.31 8 TOPAMAX 5.281.8%274.0 231.31 9 ADVAIR DISKUS 5.111.8%369.9 165.63 10 OXYCODONE HCL 4.251.5%484.3 105.38

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41 SNP Population Top 10 Therapy Classes THERAPY CLASS FIRST QUARTER 2006 Rank THERAPY CLASS PMPM% of Rx PMPMScripts / 1,000Cost / Unit 1 ANTIPSYCHOTIC AGENTS (Schizophrenia, Bipolar Disorder) $ 54.2918.9%2,995.5 $ 217.47 2 ANTICONVULSANTS, MISCELLANEOUS (Seizures, Migraines) 24.628.6%2,121.1 139.27 3 HMG-COA REDUCTASE INHIBITORS (High Cholesterol) 22.127.7%2,517.4 105.45 4 ANTIDEPRESSANTS (Depression, Nerve pain) 19.226.7%4,355.6 52.96 5 MISCELLANEOUS THERAPEUTIC AGENTS (Rheumatoid Arthritis, MS, etc.) 19.176.7%1,226.2 187.56 6 OPIATE AGONISTS (Pain) 14.585.1%3,384.3 51.69 7 ANTIRETROVIRALS (Anti-viral) 9.633.4%212.7 543.22 8 BETA-ADRENERGIC AGONISTS (Asthma, Chronic Lung Disease) 7.512.6%1,183.7 76.17 9 PLATELET-AGGREGATION INHIBITORS (Blood Clot Prevention) 5.942.1%611.0 116.67 10 PROTON-PUMP INHIBITORS (Reflux Disease, Ulcers) 5.882.0%1,828.6 38.58

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42 TOP 5 THERAPY CLASSES BY MEMBER COUNT FOR MEMBERS UTILIZING > 6 DRUGS RANKTHERAPY CLASS 1ANTIDEPRESSANTS (Depression, Nerve Pain) 2HMG-COA REDUCTASE INHIBITORS (High Cholesterol) 3OPIATE AGONISTS (Pain) 4BETA-ADRENERGIC BLOCKING AGENTS (Asthma, Lung Disease) 5PROTON-PUMP INHIBITORS (Reflux, Ulcers) # of Therapy Classes Used by MemberUnique Members% MbrsCumulative Only 11,32830.4% Any Combination of 21,63337.3%67.7% Any Combination of 399822.8%90.5% Any Combination of 43638.3%98.8% All 5531.2%100.0% Total4,375100.0%

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43 TOP 5 THERAPY CLASSES BY MEMBER COUNT FOR MEMBERS UTILIZING > 6 DRUGS

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44 Rx Utilization Trend/Drug Stratification

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45 Rx Utilization Trend/Drug Stratification

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46 Rx Utilization Drug Stratification - Month

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47 Rx Utilization Drug Stratification Age Group

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48 Rx Utilization Drug Stratification Age Group

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49 Rx Utilization Drug Stratification Age Group

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50 SNP Members Behavioral Health Analysis

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51 Behavioral Health Analysis

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52 Behavioral Health Analysis UNDER 65 Top 10 Diagnosis (PMPM) - Mental Disorder Related Only UNDER 65 Unique MembersPMPM ADMITS PER 1000 CLAIMS PER 1000 SCHIZOPHRENIC DISORDERS278$25.9152.2626.5 AFFECTIVE PSYCHOSES306$25.4257.3552.6 DEPRESSIVE DISORDER NOT ELSEWHERE C97$6.0218.5149.7 SPECIAL SYMPTOMS OR SYNDROMES NEC13$2.141.826.4 NEUROTIC DISORDERS72$1.963.0101.0 OTHER NONORGANIC PSYCHOSES37$1.873.541.7 ALCOHOLIC PSYCHOSES5$1.748.2 HYPERKINETIC SYNDROME OF CHILDHOOD1$1.422.40.6 DISTURBANCE OF CONDUCT NOT ELSEWHER19$0.892.023.5 NONDEPENDENT ABUSE OF DRUGS15$0.730.912.3

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53 Behavioral Health Analysis OVER 65 Top 10 Diagnosis (PMPM) - Mental Disorder Related Only OVER 65 Unique MembersPMPM ADMITS PER 100 0 CLAIMS PER 100 0 OTHER ORGANIC PSYCHOTIC CONDITIONS7$2.114.712.3 SCHIZOPHRENIC DISORDERS 30$1.886.658.4 AFFECTIVE PSYCHOSES 28$1.791.337.8 UNSPECIFIED MENTAL RETARDATION 1$1.620.02.5 OTHER NONORGANIC PSYCHOSES 8$0.961.514.8 NEUROTIC DISORDERS 12$0.866.916.4 DEPRESSIVE DISORDER NOT ELSEWHERE C6$0.340.013.2 DRUG PSYCHOSES 2$0.144.91.6 TRANSIENT ORGANIC PSYCHOTIC CONDITI4$0.100.09.9 SENILE&PRESENILE ORGANIC PSYCHOTIC 6$0.040.05.8

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54 Behavioral Health Analysis Comorbidities UNDER 65 Top 10 Diagnosis (PMPM) - Excludes Mental Disorders UNDER 65 Unique MembersPMPM ADMITS PER 1000 CLAIMS PER 1000 CURVATURE OF SPINE3$6.522.61.8 SYMPTOMS INVLV RESP SYSTEM&OTH CHST82$4.206.5151.5 GENERAL SYMPTOMS100$3.692.8155.6 OSTEOARTHROSIS AND ALLIED DISORDERS19$1.893.231.1 OTHER SYMPTOMS INVOLVING ABDOMEN AN39$1.210.761.1 OTHER DISORDERS OF CERVICAL REGION19$1.170.030.5 OTHER FORMS OF CHRONIC ISCHEMIC HEA10$0.940.718.8 OTHER CELLULITIS AND ABSCESS11$0.941.324.1 MULTIPLE SCLEROSIS4$0.922.410.6 INTERVERTEBRAL DISC DISORDERS26$0.840.735.2

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55 Behavioral Health Analysis Comorbidities OVER 65 Top 10 Diagnosis (PMPM) - Excludes Mental Disorders OVER 65 Unique Me mb ersPMPM ADMITS PE R 100 0 CLAIMS PE R 100 0 SYMPTOMS INVOLVING DIGESTIVE SYSTEM7$6.563.616.4 OTHER DISORDERS OF URETHRA AND URIN7$2.988.113.2 HEART FAILURE 4$1.341.812.3 GENERAL SYMPTOMS 21$1.320.040.3 OTHER CEREBRAL DEGENERATIONS 3$1.113.43.3 CARE INVOLVING USE OF REHABILITATIO4$0.701.04.1 OTHER BACTERIAL PNEUMONIA 1$0.520.90.8 OTHER DISORDERS OF SOFT TISSUES5$0.500.98.2 OTHER AND UNSPECIFIED DISORDERS OF8$0.481.012.3 SYMPTOMS INVLV NERVOUS&MUSCULOSKELE 1$0.460.00.8

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56 Behavioral Health Analysis Under 65 Age Group UNDER 65 Unique MembersPMPM ADMITS PER 1000 CLAIMS PER 1000 Member Months20,436 Total Unique Members7,149 Top 10 Diagnosis Classes Mental Disorders717$69.99155.31,637.1 Symptoms, Signs and Ill-Defined Conditions164$13.597.2345.9 Musculoskeletal System and Connective Tissue230$11.3110.0510.3 Circulatory System124$3.715.3160.3 Nervous System and Sense Organs133$3.082.4159.1 Respiratory System71$2.912.0122.7 Injury and Poisoning81$2.763.5115.1 Digestive System120$2.492.8158.5 V Codes141$1.501.4154.4 Endocrine, Nutritional, Metabolic, Immunity145$1.410.0186.7

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57 Behavioral Health Analysis Over 65 Age Group OVER 65 Unique MembersPMPM ADMITS PER 1000 CLAIMS PER 1000 Member Months14,600 Total Unique Members5,118 Top 10 Diagnosis Classes Mental Disorders89$9.8925.8180.0 Symptoms, Signs and Ill-Defined Conditions29$1.531.964.9 Musculoskeletal System and Connective Tissue42$9.794.5151.2 Circulatory System37$2.082.974.8 Nervous System and Sense Organs20$1.293.423.8 Respiratory System14$0.660.034.5 Injury and Poisoning14$0.340.923.8 Digestive System25$1.231.860.0 V Codes17$0.791.027.9 Endocrine, Nutritional, Metabolic, Immunity27$0.780.942.7

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58 Behavioral Health Analysis Top 10 Diagnostic Related Groups (DRGs) Under 65 Age Group UNDER 65 Rank Diagnostic Related Group Description UNIQUE MEMBE RSPMPMADMITS PER 1000 1 Psychoses84$46.06113.0 2 Combined Anterior/Posterior Spinal Fusion1$6.52 2.58 3 Depressive Neuroses14$4.89 19.61 4 Disorders of Personality and Impulse Control3$2.04 2.88 5 Alcohol/Drug Abuse or Dependence with CC6$1.74 7.00 6 Childhood Mental Disorders1$1.42 2.45 7 Chest Pain3$1.25 6.54 8 Local Excis & Remov of Int Fix Dev Except Hip & Femur w/o CC1$1.05 2.58 9 Esophagitis, Gastroenteritis and Miscellaneous Digestive Disorders, Age Greater than 17 with CC2$0.87 0.73 10 Peripheral Vascular Disorders with CC1$0.75 3.31

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59 Behavioral Health Analysis Top 10 Diagnostic Related Groups (DRGs) Over 65 Age Group OVER 65 Rank Diagnostic Related Group DescriptionUNIQUE MEMBERSPMPMADMITS PER 1000 1 Extensive OR Procedure Unrelated to Principal Diagnosis1$5.903.6 2 Organic Disturbances and Mental Retardation3$3.12 4.70 3 Kidney and Urinary Tract Infections, Age Greater than 17 with CC2$2.71 8.13 4 Psychoses6$2.34 9.35 5 Degenerative Nervous System Disorders1$1.10 3.43 6 Heart Failure and Shock1$0.74 1.82 7 Rehabilitation1$0.53 1.03 8 Acute Adjustment Reactions and Disturbances of Psychosocial Dysfunction1$0.52 6.86 9 Respiratory Infections and Inflammations, Age Greater than 17 with CC1$0.52 0.91 10 Signs and Symptoms without CC1$0.36 0.91